And, as someone who has saved "hundreds of lives", you should know that the only legally and ethically acceptable reasons to withhold lifesaving intervention from a patient is if they have a signed DNR order, or you have a physician telling you to.

I hate the fact that I have to code a 78 year old Alzheimer patient who was long ago confined to a bed, contractured, and has no quality of life. But I don't get to make that decision, and neither does anyone else without the above. I abhor it. And I hope I don't get someone back in that case - as many other people will admit. Life at any costs is utterly cruel. But the alternative is letting people make decisions based on their own personal bias and feelings - decisions which may or may not be the wish of that patient.

State Nursing law and the duty to act takes precedence over what that facility policy says.

To put it another way, if I have a facility policy to knowingly administer a medication when it is contraindicated to do so, and do so anyway because I am following policy and that patient dies, I have just committed, at best, negligent practice. At worst, negligent homicide.

you're not good at reading comprehension are you? cause what you said isn't the same thing as what they said. CPR isn't "prolonged intervention", and living at a place without nursing staff isn't the same as a DNR order.

Well, it didn't spell out "and before we placed her in the care of the facility, we all went to the judge and had a DNR order written and notarized, and reminded the staff to have it always taped to the foot of her bed", therefore, legally it means nada. Right?

hardinparamedic:AverageAmericanGuy: 'Contributed' is a very weasely word here.

How so? If this woman was a nurse, her training should have lead her to be able to identify the fact that this woman needed assistance, and her duty to act (if she's receiving a paycheck as a nurse) should have prompted her to render basic emergency aid until the arrival of more trained personnel. Even if this meant assisting respiration through mouth to mouth.

Her failure to act was a direct contributory factor here as a licensed nurse.

It's a way to pin responsibility on this woman without saying she is responsible for the death.

Everything is contributory to this woman's death. The water temperature in the shower. The alarm clock that woke her from slumber. The walker she hit on her fall to the floor. The question is whether she is responsible in this case, not whether her involvement contributed to the woman's death.

You think yes. Others think no. She's dead, so her opinion is mute (get it? cuz she's dead silent. LOL). And her next of kin say they are satisfied with the level of care.

California says:2727.5. Liability for emergency careA person licensed under this chapter who in good faith renders emergency care at the scene of an emergency which occurs outside both the place and the course of that person's employment shall not be liable for any civil damages as the result of acts or omissions by that person in rendering the emergency care.

So unless she was acting in a grossly negligent manner, her responsibility has been fulfilled.

The code goes on to describe 'gross negligence':1442. Gross NegligenceAs used in Section 2761 of the code, "gross negligence" includes an extreme departure from the standard of care which, under similar circumstances, would have ordinarily been exercised by a competent registered nurse. Such an extreme departure means the repeated failure to provide nursing care as required or failure to provide care or to exercise ordinary precaution in a single situation which the nurse knew, or should have known, could have jeopardized the client's health or life.

Since the nursing home had a policy of not performing CPR, you'd be hard pressed to argue that her actions constituted 'an extreme departure from the standard of care' another nurse would have performed given that those nurses would also, presumably, follow the policy.

And, as someone who has saved "hundreds of lives", you should know that the only legally and ethically acceptable reasons to withhold lifesaving intervention from a patient is if they have a signed DNR order, or you have a physician telling you to.

I hate the fact that I have to code a 78 year old Alzheimer patient who was long ago confined to a bed, contractured, and has no quality of life. But I don't get to make that decision, and neither does anyone else without the above. I abhor it. And I hope I don't get someone back in that case - as many other people will admit. Life at any costs is utterly cruel. But the alternative is letting people make decisions based on their own personal bias and feelings - decisions which may or may not be the wish of that patient.

I'm sure breaking all their ribs is *definitely* the most ethical, humane thing to do.

It doesn't matter if the family was happy with the care or not. If she was negligent, or violated the rules of her nursing practice, she needs to be held accountable for it.

While I would tend to agree...yelling "STRING HER UP!!!!" because you like looking like a hero/white knight doesn't change the fact that the FAMILY didn't want her resuscitated anyhow.

time to let it go. If the family of the woman can let it go...you probably should, too.

So, since the family is ok with it, we should be too? Thats your standard?

If I run over a hobo, and nobody knows about, its totally cool in your book? What if I find orphans without any living family members, and hack them to pieces? I mean, if they don't have a family, there isn't anybody left to get upset about it, right?

Lots of idiocy on this thread. Sounds like this "nurse" was screwed no matter which way she went. Give CPR lose job, face lawsuit. Don't give CPR face the law. It is like when they arrested that woman that played Mary Ann from Gilligan's island for having a joint, I was like, WTF. she's pushing 70 and if she wanted a joint leave her alone.

Eh, when your patient is beating the typical lifespan by fifteen years, this sort of falls under "eh, guess I could have handled that better" rather than "Oh, no! Tragedy! Negligence! Vile calumny upon thee!"

//CPR on an 87-year-old human will, typically, kill them outright. Remember that properly-performed CPR frequently results in broken ribs on a healthy patient.

hardinparamedic:me texan: Putting someone in the rescue position is not performing CPR.

Assisting for ineffective respirations, and identifying agonal breathing is not placing someone in the rescue position.

FirstNationalBastard: Of course they're happy.

Odds are, Grandma was a near-vegetable that had drained them both emotionally and financially to the brink of ruin because her body was just too stubborn to die even though the mind had checked out long ago. But, unlike if a beloved family pet's quality of life had degraded to almost nothing, no one could take Grandma to the Doctor and give her a nice sleepytime shot to put her out of her misery, because with humans, life is all about quantity, not quality.

Unless that woman had a valid, signed DNR, or had a Doctor at her side telling her not to start CPR, that does not matter. She had a legal duty, if employed as a nurse for that facility, to act in the standard of care with basic competency, per the California Board of Nursing.

Facility policies do not trump State Nursing laws.

I will point out, again, that there's no evidence Colleen was employed as a nurse. She told the dispatcher she was a nurse and the media has identified her as a nurse. But for all we know, her job was gardening.

The place was not a nursing home, but an unregulated "independent living center." As explained elsewhere, that's sort of like a hotel with intensive concierge service; it's not a medical facility. TFA says the family and Granny knew there were no "trained medical staff" available.

Finally, even the Board of Nursing does not require a nurse to put herself in harm's way in order to aid a client. Colleen faced losing her job if she violated policy. She chose her job, and she had a right to do so.

And, as someone who has saved "hundreds of lives", you should know that the only legally and ethically acceptable reasons to withhold lifesaving intervention from a patient is if they have a signed DNR order, or you have a physician telling you to.

Except that you are WRONG.

You're a medic. Not a nurse. You do not have the level of medical training that I do. And legally, I am able to determine whether or not lifesaving measures should be taken or not...or whether or not they would be effective. You, as a medic, are not licensed to make this determination. I am.

If you aren't aware that certain nurses in several states are legally allowed to make this determination, then I dont know what to tell you...except that in NO state is a medic legally able to do so.

There's a difference between "nursing home" and "independent living facility" She was at the latter, and they generally don't provide medical care. It's more helping them with daily activities, cleaning and checking on them so they can live in their own place until they die. The old bag and her family knew the policy, and were fine with it. Case closed. Stop grandstanding.

tlchwi02:hardinparamedic: You're missing the point. By state and federal law, you do not get to make that decision. That patient, through his/her advanced directives and DNR, and a Physician who can justify the witholding of resuscitative care is the only ones who can do so.

sheesh, I didn't know we had the king o' nurses on fark. who gives a crap, an old person lived in a place where she knew there weren't first responders and shockingly when she needed one, there weren't any and her family is shrugging it off. if you're that worked up about it, make sure your relatives and you lives in a place with actual medical staff on site when they/you get old. otherwise, whatever

Diogenes The Cynic:The more you eat the more you fart: hardinparamedic: Apparently, the woman did NOT have a Do Not Resuscitate order or Advanced Directive stating NO CPR.

It doesn't matter if the family was happy with the care or not. If she was negligent, or violated the rules of her nursing practice, she needs to be held accountable for it.

While I would tend to agree...yelling "STRING HER UP!!!!" because you like looking like a hero/white knight doesn't change the fact that the FAMILY didn't want her resuscitated anyhow.

time to let it go. If the family of the woman can let it go...you probably should, too.

So, since the family is ok with it, we should be too? Thats your standard?

If I run over a hobo, and nobody knows about, its totally cool in your book? What if I find orphans without any living family members, and hack them to pieces? I mean, if they don't have a family, there isn't anybody left to get upset about it, right?

Now, I'm not a doctor or a lawyer, but I am pretty sure being murdered and dying of natural causes are different in the eyes of medicine, the law, and (if that's your thing) God.

AverageAmericanGuy:So unless she was acting in a grossly negligent manner, her responsibility has been fulfilled.

The Good Samaritan law you linked does not apply in the United States civil system if the person had a duty to rescue - i.e. they were being paid and on duty at the time as a licensed healthcare provider, and there was a client-patient relationship.

Even if her job was just to come in for an hour and hand out medicine, if she was an LPN or RN, she had a legal duty to act.

AverageAmericanGuy:Since the nursing home had a policy of not performing CPR, you'd be hard pressed to argue that her actions constituted 'an extreme departure from the standard of care' another nurse would have performed given that those nurses would also, presumably, follow the policy.

Facility policy does not trump the standard of care for a nursing licensee. That is determined by the board of Nursing, based on their level.

ThunderPelvis:I'm sure breaking all their ribs is *definitely* the most ethical, humane thing to do.

Take it up with the State you live in, the American Heart Association/ILCOR, and whatever biomedical ethics board oversees your respective profession.

Ishidan:and as it turns out, as I was writing that, Hardin confirmed it...RIGHT. It's all about the paperwork.

He's had to deal with these lawyers before, I see.

Unfortunately, a large part of it is the way laws are written. Even if I have a DNR in hand, and it is missing one date, or one signature, the law says I have to consider it invalid. The risk of error is too great, as it results in certain death.

Any healthcare provider will tell you there are patients that they abhor doing CPR and working. They don't want to do it. But it's part of their job.

Ishidan:But is a nonlicensed nurse held to the same standards as a licensed paramedic?

If she was an LPN or RN, she is licensed. Even if she's certified - actually a nursing assistant, the board still has jurisdiction over her certification. Although, if she was actually a Nursing Assistant, she would not be held to the same standard to act in the least.

As far as nurses being like paramedics - that's kind of a complex issue. Different schools of thought, different methodologies of training.

Paramedics specialize in emergency and critical care, especially in the venue of transport, and have to learn to generalize. Nurses generalize in advanced care, and specialize in their respective clinical fields out in practice.

And, as someone who has saved "hundreds of lives", you should know that the only legally and ethically acceptable reasons to withhold lifesaving intervention from a patient is if they have a signed DNR order, or you have a physician telling you to.

Except that you are WRONG.

You're a medic. Not a nurse. You do not have the level of medical training that I do. And legally, I am able to determine whether or not lifesaving measures should be taken or not...or whether or not they would be effective. You, as a medic, are not licensed to make this determination. I am.

If you aren't aware that certain nurses in several states are legally allowed to make this determination, then I dont know what to tell you...except that in NO state is a medic legally able to do so.

Also, from what I understand is that if I am not trained to preform CPR correctly I am not to do so. It is more than pounding on a chest. Of course, I'm from a "flyover" state and it varies from state to state.

The more you eat the more you fart:You're a medic. Not a nurse. You do not have the level of medical training that I do. And legally, I am able to determine whether or not lifesaving measures should be taken or not...or whether or not they would be effective. You, as a medic, are not licensed to make this determination. I am.

If you aren't aware that certain nurses in several states are legally allowed to make this determination, then I dont know what to tell you...except that in NO state is a medic legally able to do so.

What level of medical training is that which allows you to determine that, without performing an assessment or any interventions, that death in the field is certain and resuscitation is futile. Or to withhold resuscitation measures without a DNR or physicians order, or specific standing, protocol-based criteria, despite the fact doing so can be seen as practicing medicine?

Jim_Callahan:Eh, when your patient is beating the typical lifespan by fifteen years, this sort of falls under "eh, guess I could have handled that better" rather than "Oh, no! Tragedy! Negligence! Vile calumny upon thee!"

//CPR on an 87-year-old human will, typically, kill them outright. Remember that properly-performed CPR frequently results in broken ribs on a healthy patient.

I get all that. What I don't get is why so many seem to misunderstand why anyone might be disturbed by the story we've gotten so far...

Look, it would be one thing if the nurse and the 911 operator were having a debate about best medical practices...and the nurse decided to err on the side of humaneness, rather than take a risky and potentially unrewarding, drastic measure for their client.

But, that's not really what the story is about, is it? Tell me you get that...

BarkingUnicorn:The place was not a nursing home, but an unregulated "independent living center."

andychrist420:There's a difference between "nursing home" and "independent living facility" She was at the latter, and they generally don't provide medical care.

you guys think you're making some sort of point by saying this, but it is completely irrelevant.

If a bagger at a grocery store called 911 because a customer was dieing then refused to perform CPR when asked by the 911 operator because it was against company policy, no one would be saying "well he wasn't at a nursing home so the customer should just expect to die".

Bigdogdaddy:The more you eat the more you fart: hardinparamedic: The more you eat the more you fart: REALLY?!

The family's response to the media "outrage"....

And, as someone who has saved "hundreds of lives", you should know that the only legally and ethically acceptable reasons to withhold lifesaving intervention from a patient is if they have a signed DNR order, or you have a physician telling you to.

Except that you are WRONG.

You're a medic. Not a nurse. You do not have the level of medical training that I do. And legally, I am able to determine whether or not lifesaving measures should be taken or not...or whether or not they would be effective. You, as a medic, are not licensed to make this determination. I am.

If you aren't aware that certain nurses in several states are legally allowed to make this determination, then I dont know what to tell you...except that in NO state is a medic legally able to do so.

Also, from what I understand is that if I am not trained to preform CPR correctly I am not to do so. It is more than pounding on a chest. Of course, I'm from a "flyover" state and it varies from state to state.

Flyover state, huh? I believe it is your job to drop to your knees and pray. Remember to make a show of it so that everyone around you will know that you are morally superior to them, even those actually doing something about the situation.

hardinparamedic:It does not matter if that woman was a licensed nurse in the employ of that capacity in that "assisted living" facility. Her employment as a nurse means she is held to the standards of the California Board of Nursing, and required to adhere to the standards of care that board expects, given the capabilities she had at the time. The client-provider relationship alone creates a duty to rescue, and a duty to act.

Facility policy does not trump the State Guidelines for standard of care, and the requirement of a physician order or signed, properly executed DNR/Advanced Directive to be present for CPR and lifesaving care to be withheld.

So far, there has been no identification of who actually made the call, and there has been no actual evidence presented that she is a licensed nurse. Also, it was NOT an assisted living facility. It was an independent living facility which doesn't have to meet the standards of an Assisted living facility. I've been trying to find the exact standards, but searches for ILCs in California turns up only non-residential organizations aimed towards the disabled, were 51% of the employees and board are disabled. Its not clear if this was that type of ILC or another one that I can't find through google.However, the article states that the woman selected the facility knowing that there were not "trained medical staff" on hand, and all indications given by family are that she wanted no intervention.

Rising_Zan_Samurai_Gunman: While I can understand why some people are seemingly upset over what happened, the family is ok with it, so it should all be good.

And that's good. There will be no civil action, and the family can have their peace. The problem here is that a person either identified herself as a "nurse" falsely, or was a licensed nurse who refused to perform her state's expected standard of care. It doesn't matter, in that case, if her patient's family was happy with the standard of care.

Her actions directly contributed to the death of a patient. If her only justification was "it's our policy", she's about to find out how harsh a medical licensing board can be.

Correction - the woman took no actions which contributed to the death of the patient. Her inaction beyond placing the call may have delayed care to the woman, but once again, the information at this time indicates that the employees involved, or at least the one who made the initial call (the article indicates two different employees were on the call) was not a licensed nurse. The license status of the second employee on the call is also unknown.

You're missing the point. By state and federal law, you do not get to make that decision. That patient, through his/her advanced directives and DNR, and a Physician who can justify the witholding of resuscitative care is the only ones who can do so.

And the information provided by the family so far indicated that the woman's directives were to not take any extraordinary measures to extend her life. As an independent living facility its probable there is no physician on staff to place any sort of order. The only description of Independent Living Facility I've been able to find for California is a non-residential situation, so it may be a community center where all of the "residents" are independent but live nearby.

log_jammin:Rising_Zan_Samurai_Gunman: and the residents are informed of what care will and will not be given when they choose to live there

You think they were informed that during a medical emergency the staff would call 911 then refuse to do what 911 told them to do?

They were likely told they would call 911 but take no additional measures.

Rising_Zan_Samurai_Gunman: CPR most likely wouldn't have saved her life

hardinparamedic:cretinbob: She's not a nurse. She had no duty to act. I still haven't heard the 911 recording where she identifies herself as a nurse either. I've just read it.

Really? Because every article I've read on the matter identifies her as a "nurse".

Yes, but if you read the linked article, you'll see that she has been identified as a residential manager. Yes, apprently she identified herself as a nurse, but she isn't.

Wait, the article changed again......

I'll find it.....

Anway she died of a massive stroke, so all the CPR in the world wouldn't have fixed that anyway.CPR is not a magic wand to wave over someone and they come back to life.Life is terminal. Everyone dies. It's OK. That's how you get to go to heaven.If there should be a discussion here it's that.

//an echo response would be cardiac and respiratory arrest, witnessed with CPR in progress. This would have been a Delta response which is still an emergency response.

BAKERSFIELD, Calif. - Glenwood Gardens is an independent living facility, which by law is not licensed to provide medical care to any of its residents.We are conducting an internal review to determine all of the facts about what occurred while waiting for the paramedics, who arrived moments later. Our associate who was involved was serving in the capacity of a Resident Services Director, not as a nurse.We have communicated our deepest sympathies and condolences to this resident's family on the passing of their loved one.

BarkingUnicorn:Your morals do not create my duties. If your morals say abortion is murder, I have no duty to carry a fetus to term.

Get it?

so unless you have a legal obligation then you can't be bothered. got it.

Rising_Zan_Samurai_Gunman:Reports are that she died of a massive stroke and had been diagnosed with a disease of the blood vessels supplying the brain, so CPR would have at best, left her a vegetable.

We asked her if CPR would have done any good in this case."it could have made a difference. Would it have made a difference in this particular situation? We don't have the answer to that, but have patients survived in a similar situation," said Shain.

hardinparamedic:AverageAmericanGuy: So unless she was acting in a grossly negligent manner, her responsibility has been fulfilled.

The Good Samaritan law you linked does not apply in the United States civil system if the person had a duty to rescue - i.e. they were being paid and on duty at the time as a licensed healthcare provider, and there was a client-patient relationship.

That would actually be the Nursing Practice Act, not the Good Samaritan law.

citation that 911 dispatchers are trained to provide instructions on how to perform CPR during emergencies? cause that's a pretty major part of their job. Or are you claiming that the 911 operator was telling to woman to do something illegal by asking her to perform 911?

log_jammin:BarkingUnicorn: The place was not a nursing home, but an unregulated "independent living center."

andychrist420: There's a difference between "nursing home" and "independent living facility" She was at the latter, and they generally don't provide medical care.

you guys think you're making some sort of point by saying this, but it is completely irrelevant.

If a bagger at a grocery store called 911 because a customer was dieing then refused to perform CPR when asked by the 911 operator because it was against company policy, no one would be saying "well he wasn't at a nursing home so the customer should just expect to die".

If the bagger is not trained in CPR, he should not do it, and could actually be liable if the person is injured further. Anything else?

And, as someone who has saved "hundreds of lives", you should know that the only legally and ethically acceptable reasons to withhold lifesaving intervention from a patient is if they have a signed DNR order, or you have a physician telling you to.

Except that you are WRONG.

You're a medic. Not a nurse. You do not have the level of medical training that I do. And legally, I am able to determine whether or not lifesaving measures should be taken or not...or whether or not they would be effective. You, as a medic, are not licensed to make this determination. I am.

If you aren't aware that certain nurses in several states are legally allowed to make this determination, then I dont know what to tell you...except that in NO state is a medic legally able to do so.

Wow, as a nurse I am embarrassed for you. You must not be an emergency nurse which automatically disqualifies you from the "I can decide if I should continue CPR" crowd. I would LOVE to see your State's Nurse practice act because I have never heard this. Most of what nurses can do are centered on identifying problems a patient is having. If you did not have a patient hooked up to a monitor and rigor mortis was not setting in, I'd say you were playing with fire telling people to stop what they are doing.

Bigdogdaddy:The more you eat the more you fart: hardinparamedic: The more you eat the more you fart: REALLY?!

The family's response to the media "outrage"....

And, as someone who has saved "hundreds of lives", you should know that the only legally and ethically acceptable reasons to withhold lifesaving intervention from a patient is if they have a signed DNR order, or you have a physician telling you to.

Except that you are WRONG.

You're a medic. Not a nurse. You do not have the level of medical training that I do. And legally, I am able to determine whether or not lifesaving measures should be taken or not...or whether or not they would be effective. You, as a medic, are not licensed to make this determination. I am.

If you aren't aware that certain nurses in several states are legally allowed to make this determination, then I dont know what to tell you...except that in NO state is a medic legally able to do so.

Also, from what I understand is that if I am not trained to preform CPR correctly I am not to do so. It is more than pounding on a chest. Of course, I'm from a "flyover" state and it varies from state to state.

Correct. If you dont know how to do it...at the least its gonna be ineffective, and at the worst, can actually make a bad situation even worse.

Also, I would suggest hardinparamedic stops trying to speak about the state board of nursing like he actually has authority to do so, or that he even knows wtf their rules are...considering that he isn't even a nurse.

"Lorraine Bayless' family said she "personally selected" Glenwood Gardens independent living facility in Bakersfield knowing there were not "trained medical staff" and that she wanted to "die naturally...without any kind of life-prolonging intervention." "

My dad was dying of cancer, but weak and frail that he was, he got himself up and dressed and to his chair on his last day. To make a long story short, he collapsed, I called 911. I did not perform CPR and he had a DNR. Crushing his ribs might have kept him alive, what? A week or so more? Robbed of his independence from the damage caused by such actions and very likely in more severe pain?? I would love to have my dad back, I miss him terribly and I second-guess my actions to this day, 9yrs later, even though I know I did the right thing. It was painful to go through, but the death he would have preferred was there for him. Yes, we have all sorts of BS legal shiat to worry about these days, but it sounds to me like this family and nurse were abiding by what was right for the woman and her wishes. May Ms. Bayless rest in peace, may her family be left in peace in this sad time, and can we all please learn a bit from their common sense?

"Bayless' family reiterated in their statement that they had no qualms with the care Bayless received.

"We understand that the 911 tape of this event has caused concern, but our family knows that mom had full knowledge of the limitations of Glenwood Gardens and is at peace," the statement from Bayless' family read."

As far as nurses being like paramedics - that's kind of a complex issue. Different schools of thought, different methodologies of training.

Paramedics specialize in emergency and critical care, especially in the venue of transport, and have to learn to generalize. Nurses generalize in advanced care, and specialize in their respective clinical fields out in practice.

Just wanted to reinforce this. RN here. Nurses (in general) are more experienced in "longer" term care than nurses. Unless the RN is working in an ED or on a medivac I would not think their emergency medicine care is that much better than a paramedic's. Nurses and paramedics, for the most part, serve different spectrums of the medical world. They each have their place and are specialized for their specific job.

As for the original topic, I'm still trying to absorb all the information before making a decision. Although, as a nurse, I would find it difficult to just refuse treatment. Providing medical care or treatment is just second nature to a lot of people in the medical professions. You kinda go on "autopilot" in those emergency situations. So, for some reason, I feel like there's some disconnect in the story or something not being reported. It just isn't adding up.

citation that 911 dispatchers are trained to provide instructions on how to perform CPR during emergencies? cause that's a pretty major part of their job. Or are you claiming that the 911 operator was telling to woman to do something illegal by asking her to perform 911?

If someone was trapped in a burning car and I would put my life in danger should I be required to drag them out? One can't be required to do anything they do not feel like doing.